Ace provided, list all employer-sponsored recreational activities and fitness programs for which the employee wishes to waive workers compensation coverage. Make a line through any blank spaces. The employee must sign and date this form to acknowledge agreement. The employer shall retain the original for his or her files and provide a copy to the employee. The employer should submit a copy to BWC only when an employee files a claim for an injury or occupational disease sustained i.
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How to fill out the OH C-159 online
The OH C-159 form is essential for employees wishing to waive workers’ compensation coverage for participation in employer-sponsored recreational activities or fitness programs. This guide provides clear instructions on how to accurately complete the form online, ensuring you meet all necessary requirements.
Follow the steps to complete the OH C-159 form online.
- Click the 'Get Form' button to obtain the form and open it in the editor.
- Begin by entering the employee name in the designated field. Ensure this is clearly printed or typed, as it will be used for record-keeping.
- Next, indicate the date on which you are filling out the form. This is important for tracking the waiver's validity period.
- In the employer name field, provide the full name of the employer sponsoring the recreational activities or fitness programs.
- Enter the policy number associated with your employer's workers’ compensation coverage. This helps in identifying the specific coverage applicable.
- List all employer-sponsored recreational activities and fitness programs for which you wish to waive workers’ compensation coverage. Make sure to clearly document each activity, and draw a line through any blank spaces.
- Review your entries carefully. Sign and date the form at the designated locations to acknowledge your agreement to waive rights to workers' compensation benefits for the activities listed.
- After completing the form, save your changes, and download a copy for your records. You may also print or share the completed form as required.
Take action today by filling out your OH C-159 form online for a smooth and efficient process.
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